Re: Recognition and management of psychosis and schizophrenia in children and young people : summary of NICE guidance.

The publication of NICE guidelines relating to the Recognition and management of Psychosis and Schizophrenia in children and young people 1 is to be welcomed given the lack of published guidance in this area, especially concerning the management of young people deemed to be at high risk of psychosis 2,3. However, we feel that the working group may have missed an opportunity to incorporate the views of current adolescent service users. The guideline development process included service-user representation at all stages. However, there was a dearth of published literature in relation to the experiences and treatment preferences of child and adolescent service users with psychosis to draw on 4 although we note the guidelines did not reference our recently published study in this area 5. Indeed, this is a patient group rarely consulted, possibly due to a perception that young people may find it difficult to articulate hallucinatory experiences or have inaccurate recall of events 6,7. However, there is a growing acceptance that eliciting and learning from service users' views is an important means of improving the quality of future health care and research within the NHS 8,9. Indeed, where the evidence base is uncertain, as in the present case, patient preferences may play a more significant role in treatment selection 10. In response to our concerns we are working with our local Early Intervention in Psychosis service to address this issue by offering information to young people describing possible therapeutic options and asking them to state their preferences

Protective Effects of Calcium Against Chronic Waterborne Cadmium Exposure to Juvenile Rainbow Trout

Juvenile rainbow trout (Oncorhynchus mykiss [Walbaum]) on 1% daily ration were exposed to 0 (control) or 2 μg of cadmium as Cd(NO3)2·4H2O per liter added to four different calcium (Ca) concentrations: 260 (background), 470 (low), 770 (medium), or 1200 (high) μM of Ca added as Cd(NO3)2·4H2O in synthetic soft water for 30 d. Mortality was highest (;80%) in the background 1 Cd treatment. Approximately 40% mortality was observed in the low 1 Cd exposure; mortality was 10% or less for all other treatments. No growth effects were seen for any of the exposures. Kidneys accumulated the greatest concentration of Cd during the 30 d, followed by gills and livers. Accumulation of Cd in gills, kidney, and liver decreased at higher water Ca concentrations. No differences in whole-body or plasma Ca concentrations were found. Swimming performance was impaired in the low + Cd-exposed fish. Influx of Ca2+ into whole bodies decreased as water Ca concentrations increased; influx of Ca2+ into background + Cd–treated fish was significantly reduced compared to that in control fish. Experiments that measured uptake of new Cd into gills showed that the affinity of gills for Cd (KCd-gill) and the number of binding sites for Cd decreased as water Ca concentrations increased. Acute accumulation of new Cd into gills and number of gill Cd-binding sites increased with chronic Cd exposure, whereas the affinity of gills for Cd decreased with chronic Cd exposure. Longer-term gill binding (72 h) showed reduced uptake of new Cd at higher water Ca levels and increased uptake with chronic Cd exposure. Complications were found in applying the biotic ligand model to fish that were chronically exposed to Cd because of discrepancies in the maximum number of gill Cd-binding sites among different studies

Screening for autism in preterm children : diagnostic utility of the Social Communication Questionnaire

Objective Preterm survivors are at high risk for autism spectrum disorders (ASD). The diagnostic utility of the Social Communication Questionnaire (SCQ) in screening for ASD was assessed in extremely preterm children at 11 years of age. Design All babies born at <26 weeks gestation in UK and Ireland from March through December 1995 were recruited to the EPICure Study. Of 307 survivors, 219 (71%) were assessed at 11 years. Parents of 173 children completed the SCQ to screen for autistic features and the Development and Well Being Assessment (DAWBA) psychiatric interview. A consensus diagnosis of ASD was assigned by two child psychiatrists following review of the DAWBA parental interview and corresponding DAWBA teacher questionnaire. Setting Community-based follow-up. Results Using the established SCQ cut-off (scores ≥15), 28 (16%) extremely preterm children screened positive for ASD. Eleven (6%) were assigned a diagnosis of ASD. Using this cut-off, the SCQ had 82% sensitivity and 88% specifi city for identifying ASD in this population. Using a receiver operating characteristic curve, SCQ scores ≥14 had optimal diagnostic utility (area under curve: 0.94; sensitivity: 91%; specifi city: 86%). Positive predictive value was relatively low (31%) resulting in numerous over-referrals. However, children with false positive screens had signifi cantly worse neuro-developmental, cognitive and behavioural outcomes than those with true negative screens. Conclusion The SCQ has good diagnostic utility for identifying ASD in extremely preterm children and is a useful screening tool in this population. Children with false positive screens represent a high-risk group in whom further diagnostic assessment would be benefi cial

Digital technology: coming of age?

Editoria

Less is More: Exploiting the Standard Compiler Optimization Levels for Better Performance and Energy Consumption

This paper presents the interesting observation that by performing fewer of the optimizations available in a standard compiler optimization level such as -O2, while preserving their original ordering, significant savings can be achieved in both execution time and energy consumption. This observation has been validated on two embedded processors, namely the ARM Cortex-M0 and the ARM Cortex-M3, using two different versions of the LLVM compilation framework; v3.8 and v5.0. Experimental evaluation with 71 embedded benchmarks demonstrated performance gains for at least half of the benchmarks for both processors. An average execution time reduction of 2.4% and 5.3% was achieved across all the benchmarks for the Cortex-M0 and Cortex-M3 processors, respectively, with execution time improvements ranging from 1% up to 90% over the -O2. The savings that can be achieved are in the same range as what can be achieved by the state-of-the-art compilation approaches that use iterative compilation or machine learning to select flags or to determine phase orderings that result in more efficient code. In contrast to these time consuming and expensive to apply techniques, our approach only needs to test a limited number of optimization configurations, less than 64, to obtain similar or even better savings. Furthermore, our approach can support multi-criteria optimization as it targets execution time, energy consumption and code size at the same time.Comment: 15 pages, 3 figures, 71 benchmarks used for evaluatio

The normal inhibition of associations is impaired by clonidine in Tourette syndrome

Objective: We examined the inhibition of stimulus-stimulus associations (formally ‘conditioned inhibition’) in Tourette syndrome (TS). Method: The present study used video game style conditioned inhibition procedures suitable for children and adolescents. We tested 15 participants with a clinical diagnosis of TS in the absence of co-morbid attention deficit hyperactivity disorder and compared them with 19 typically developing age and sex matched controls (both groups aged 10–20 years). All children were tested for inhibition by summation test using two test stimuli in each of two conditioned inhibition tasks. Results: TS participants showed overall normal inhibition of stimulus-stimulus associations, and there was no correlation between inhibitory learning scores and symptom severity ratings. However, there was a clear reduction in conditioned inhibition in 7 TS participants medicated with clonidine. There was no significant effect of medication on excitatory learning of the stimulus-stimulus associations. Conclusions: We suggest that clonidine’s effect on inhibitory as opposed to excitatory learning could be related to reduced noradrenergic activity. In terms of clinical implications for TS, impaired conditioned inhibition could reduce the ability of susceptible individuals to learn to control tics in the presence of associative triggers

Services for young people with attention deficit/hyperactivity disorder transitioning from child to adult mental health services: a national survey of mental health trusts in England.

Transition from child to adult mental health services is considered to be a difficult process, particularly for individuals with neurodevelopmental disorders such as attention deficit/hyperactivity disorder (ADHD). This article presents results from a national survey of 36 mental health National Health Service (NHS) trusts across England, the findings indicate a lack of accurate data on the number of young people with ADHD transitioning to, and being seen by, adult services. Less than half of the trusts had a specialist adult ADHD service and in only a third of the trusts were there specific commissioning arrangements for adult ADHD. Half of the trusts reported that young people with ADHD were prematurely discharged from child and adolescent mental health services (CAMHS) because there were no suitable adult services. There was also a lack of written transition protocols, care pathways, commissioned services for adults with ADHD and inadequate information sharing between services. The findings advocate the need to provide a better transition service underpinned by clear, structured guidelines and protocols, routine data collection and information sharing across child and adult services. An increase in the commission of specialist adult ADHD clinics is needed to ensure individuals have access to appropriate support and care

Enhanced saccadic control in young people with Tourette syndrome despite slowed pro-saccades

Tourette syndrome (TS) is a neurodevelopmental disorder characterised by motor and vocal tics. Tics are repetitive and uncontrolled behaviours that have been associated with basal ganglia dysfunction. We investigated saccadic eye movements in a group of young people with TS but without co-morbid ADHD. Participants performed two tasks. One required them to perform only pro-saccade responses (pure pro-saccade task). The other involved shifting, unpredictably, between executing pro- and anti-saccades (mixed saccade task). We show that in the mixing saccade task, the TS group make significantly fewer errors than an age-matched control group, while responding equally fast. By contrast, on the pure pro-saccade task the TS group were shown to be significantly slower to initiate and to complete the saccades (longer movement duration and decreased peak velocity) than controls, while movement amplitude and direction accuracy were not different. These findings demonstrate enhanced shifting ability despite slower reflexive responding in TS and are discussed with respect to a disorder-related adaptation for increased cognitive regulation of behaviour

The Effectiveness of Web-Based Interventions Delivered to Children and Young People With Neurodevelopmental Disorders: Systematic Review and Meta-Analysis

Background: The prevalence of certain neurodevelopmental disorders, specifically autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), has been increasing over the last four decades. Nonpharmacological interventions are available that can improve outcomes and reduce associated symptoms such as anxiety, but these are often difficult to access. Children and young people are using the internet and digital technology at higher rates than any other demographic, but although Web-based interventions have the potential to improve health outcomes in those with long-term conditions, no previous reviews have investigated the effectiveness of Web-based interventions delivered to children and young people with neurodevelopmental disorders.Objective: This study aimed to review the effectiveness of randomized controlled trials (RCTs) of Web-based interventions delivered to children and young people with neurodevelopmental disorders.Methods: Six databases and one trial register were searched in August and September 2018. RCTs were included if they were published in a peer-reviewed journal. Interventions were included if they (1) aimed to improve the diagnostic symptomology of the targeted neurodevelopmental disorder or associated psychological symptoms as measured by a valid and reliable outcome measure; (2) were delivered on the Web; (3) targeted a youth population (aged ≤18 years or reported a mean age of ≤18 years) with a diagnosis or suspected diagnosis of a neurodevelopmental disorder. Methodological quality was rated using the Joanna Briggs Institute Critical Appraisal Checklist for RCTs.Results: Of 5140 studies retrieved, 10 fulfilled the inclusion criteria. Half of the interventions were delivered to children and young people with ASDs with the other five targeting ADHD, tic disorder, dyscalculia, and specific learning disorder. In total, 6 of the 10 trials found that a Web-based intervention was effective in improving condition-specific outcomes or reducing comorbid psychological symptoms in children and young people. The 4 trials that failed to find an effect were all delivered by apps. The meta-analysis was conducted on five of the trials and did not show a significant effect, with a high level of heterogeneity detected (n=182 [33.4%, 182/545], 5 RCTs; pooled standardized mean difference=–0.39; 95% CI –0.98 to 0.20; Z=–1.29; P=.19 [I2=72%; P=.006]).Conclusions: Web-based interventions can be effective in reducing symptoms in children and young people with neurodevelopmental disorders; however, caution should be taken when interpreting these findings owing to methodological limitations, the minimal number of papers retrieved, and small samples of included studies. Overall, the number of studies was small and mainly limited to ASD, thus restricting the generalizability of the findings